Published date: Nov 21 2024

Journal Title: Dubai Medical Journal

Issue title: Dubai Medical Journal (DMJ): Volume 7 Issue 2

Pages: 63–86

DOI: 10.18502/dmj.v7i2.17672

Salwa B. El-Sobkeysalwa.elsobkey@actvet.gov.aePhysiotherapy Department, Fatima College of Health Sciences, Al Ain, Abu Dhabi

Bassem M. FoudaFaculty of Physical Therapy, Modern University for Technology and Information, Cairo

Radwa S. AhmedFaculty of Physical Therapy, Modern University for Technology and Information, Cairo

Dalia G. El-SayedFaculty of Physical Therapy, Modern University for Technology and Information, Cairo

Introduction: Noncommunicable diseases (NCDs) such as heart diseases, type II diabetes mellitus, cancers, and stroke represent significant public health challenges globally. Modifiable risk factors, including insufficient physical activity (PA), overweight or obesity, and smoking, contribute significantly to the prevalence of these diseases. The transtheoretical model (TTM) offers a structured approach to behavior change, identifying stages of readiness and change processes. This systematic review (SR) aims to evaluate the effectiveness of TTM-based interventions in promoting healthy behaviors to mitigate these risk factors.

Methods: This systematic review addresses the PICO question: In adults aged 18 years and older with modifiable risk behaviors related to NCDs, how effective are TTM-based interventions compared to standard care in increasing physical activity levels (PAL), reducing weight or body mass index, improving dietary habits, and promoting smoking cessation (SC)? A comprehensive search of predetermined databases was conducted using nine research strings, adhering to strict inclusion and exclusion criteria. A six-stage process was employed to select studies for inclusion, followed by data extraction and narrative synthesis to identify relevant patterns, trends, and associations.

Results: Of the 259 articles retrieved, eight met the inclusion criteria. Baseline assessments determined participants’ readiness for change. TTM-based interventions included feedback or counseling sessions, feedback materials, and reports delivered in-person, online, and by telephone. Follow-up durations varied from 2 weeks to 2 years. Five out of six studies supported the effectiveness of TTM-based interventions in enhancing PAL. Four out of five studies demonstrated their efficacy in weight management and improving dietary habits. However, only two out of five studies confirmed their effectiveness in SC.

Discussion: The findings indicate that TTM-based interventions are promising for improving PAL and, to a lesser extent, for managing weight and promoting healthy dietary behaviors. The limited effectiveness observed in SC interventions suggest a need for further research and possibly tailored strategies within this context.

Conclusion: TTM-based interventions effectively promote PA and weight management, with moderate success in improving dietary habits. However, their effectiveness in SC remains inconclusive, highlighting the necessity for further investigation and potential refinement of intervention strategies.

Keywords: noncommunicable diseases (NCDs), transtheoretical model (TTM), behavior change, physical activity levels (PAL), weight management, smoking cessation

[1] Budreviciute A, Damiati S, Sabir DK, Onder K, Schuller-Goetzburg P, Plakys G, et al. Management and prevention strategies for non-communicable diseases (NCDs) and their risk factors. Front Public Health. 2020;8:574111. doi: 10.3389/fpubh.2020.574111. PMID: 33324597; PMCID: PMC7726193.

[2] Passi SJ. Prevention of non-communicable diseases by balanced nutrition: Population-specific effective public health approaches in developing countries. Curr Diabetes Rev. 2017;13(5):461-476. doi: 10.2174/1573399812666160905105951. PMID: 27593512.

[3] Naja F, Shatila H, Meho L, Alameddine M, Haber S, Nasreddine L, et al. Gaps and opportunities for nutrition research in relation to non-communicable diseases in Arab countries: Call for an informed research agenda. Nutr Res. 2017;47:1-12. doi: 10.1016/j.nutres.2017.07.011. Epub 2017 Aug 3. PMID: 29241573.

[4] Horton R. Non-communicable diseases: 2015 to 2025. Lancet. 2013;381(9866):509-510.

[5] World Health Organization [Internet]. Geneva: World Health Organization; 2019. Global Health Observatory (GHO) data. Deaths from NCDs [Internet]. Available from: https://www.who.int/gho/ncd/ mortality_morbidity/ncd_total/en/ Accessed 25 February 2024.

[6] Fahs PS, Pribulick M, Williams IC, James GD, Rovnyak V, Seibold-Simpson SM. Promoting heart health in rural women. J Rural Health. 2013;29(3):248-257. doi: 10.1111/j.1748-0361.2012.00442.x. Epub 2012 Oct 25. Erratum in: J Rural Health. 2014;30(1):120. PMID: 23802927; PMCID: PMC3695442.

[7] World Health Organization. Global status report on noncommunicable diseases 2014. Geneva: World Health Organization; 2014. Available from: https://apps.who.int/iris/bitstream/handle/10665/148114/ 9789241564854_eng.pdf?sequence=1 Accessed 25 February 2024.

[8] Stenholm S, Head J, Aalto V, Kivimäki M, Kawachi I, Zins M, et al. Body mass index as a predictor of healthy and disease-free life expectancy between ages 50 and 75: A multicohort study. Int J Obes. 2017;41(5):769-775.

[9] Australian Institute of Health and Welfare: Risk Factors Contributing to Chronic Disease. Cat No. PHE 157. Canberra: AIHW; 2012.

[10] World Health Organization. Physical activity [Internet]. Geneva: World Health Organization; 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/physical-activity

[11] World Health Organization. Global Status Report on Physical Activity 2022 [Internet]. Geneva: World Health Organization; 2024. Available from: https://www.who.int/teams/health-promotion/physicalactivity/ global-status-report-on-physical-activity-2022

[12] Yang X, Sun J, Zhang W. Global trends in burden of type 2 diabetes attributable to physical inactivity across 204 countries and territories, 1990-2019. Front Endocrinol (Lausanne). 2024; 15:1343002. doi: 10.3389/fendo.2024.1343002. PMID: 38469145; PMCID: PMC10925666.

[13] de Freitas PP, de Menezes MC, Dos Santos LC, Pimenta AM, Ferreira AVM, Lopes ACS. The transtheoretical model is an effective weight management intervention: A randomized controlled trial. BMC Public Health. 2020;20(1):652. doi: 10.1186/s12889-020-08796-1. PMID: 32393214; PMCID: PMC7216547.

[14] World Health Organization (WHO). Obesity and overweight [Internet]. Geneva: World Health Organization; 2024. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/ Accessed 3 March 2024.

[15] Das D, Menon I, Gupta R, Sharma A, Ahsan I, Ashraf AA. Comparison of interventional methods to motivate and change the behavioural stage of smokers to quit smoking: A hospital based randomised controlled trial. Asian Pac J Cancer Prev. 2021; 22:711-717.

[16] World Health Organization (WHO). Global action plan for the prevention and control of noncommunicable diseases 2013-2020. Geneva: WHO; 2013. Available from: https://apps.who.int/iris/bitstream/ handle/10665/94384/9789241506236_eng.pdf?sequence=1 Accessed 25 February 2024.

[17] Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, weight watchers, and zone diets for weight loss and heart disease risk reduction: A randomized trial. JAMA. 2005; 293:43-53.

[18] Katan MB. Weight-loss diets for the prevention and treatment of obesity. N Engl J Med. 2009;360:923- 925.

[19] Mastellos N, Gunn LH, Felix LM, Car J, Majeed A. Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Database Syst Rev. 2014;(2):CD008066. doi: 10.1002/14651858.CD008066.pub3

[20] Hartmann-Boyce J, Johns DJ, Jebb SA, Aveyard P; Behavioural weight management review group. Effect of behavioural techniques and delivery mode on effectiveness of weight management: Systematic review, meta-analysis, and meta-regression. Obes Rev. 2014;15:598-609.

[21] Norcross JC, Krebs PM, Prochaska JO. Stages of change. J Clin Psychol. 2011; 67:143-154.

[22] Papandonatos GD, Williams DM, Jennings EG, Napolitano MA, Bock BC, Dunsiger S, et al. Mediators of physical activity behavior change: Findings from a 12-month randomized controlled trial. Health Psychol. 2012;31(4):512-520. doi: 10.1037/a0026667. Epub 2011 Dec 12. PMID: 22149130; PMCID: PMC5718351.

[23] Behavioral Change Models. Transtheoretical model (Stages of Changes) [Internet]. Available from: https://sphweb.bumc.bu.edu/otlt/mph-modules/sb/behavioralchangetheories/ behavioralchangetheories6.html Accessed 29 February 2024.

[24] Johnson SS, Paiva AL, Cummins CO, Johnson JL, Dyment SJ, Wright JA, et al. Transtheoretical modelbased multiple behavior intervention for weight management: Effectiveness on a population basis. Prev Med. 2008;46(3):238-246. doi: 10.1016/j.ypmed.2007.09.010. Epub 2007 Oct 23. PMID: 18055007; PMCID: PMC2327253.

[25] Hashemzadeh M, Rahimi A, Zare-Farashbandi F, Alavi-Naeini AM, Daei A. Transtheoretical model of health behavioral change: A systematic review. Iran J Nurs Midwifery Res. 2019;24(2):83-90. doi: 10.4103/ijnmr.IJNMR_94_17. PMID: 30820217; PMCID: PMC6390443.

[26] Prochaska JO, Diclemente CC. Transtheoretical therapy: Toward a more integrative model of change. Psychother Theory Res Pract. 1982;19:276-288.

[27] Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan — a web and mobile app for systematic reviews. Syst Rev. 2016;5:210. doi: 10.1186/s13643-016-0384-4

[28] Steptoe A, Kerry S, Rink E, Hilton S. The impact of behavioral counseling on stage of change in fat intake, physical activity, and cigarette smoking in adults at increased risk of coronary heart disease. Am J Public Health. 2001;91(2):265-269. doi: 10.2105/ajph.91.2.265. PMID: 11211636; PMCID: PMC1446539.

[29] Prochaska JO, Butterworth S, Redding CA, Burden V, Perrin N, Leo M, et al. Initial efficacy of MI, TTM tailoring and HRI’s with multiple behaviors for employee health promotion. Prev Med. 2008;46:226-231.

[30] Bevilaqua CA, Pelloso SM, Marcon SS. Stages of change of behavior in women on a multi-professional program for treatment of obesity. Rev Lat Am Enfermagem. 2016 Oct 10;24. doi: 10.1590/1518- 8345.0549.2809. PMID: 27737377; PMCID: PMC5068905.

[31] DiClemente CC, Prochaska JO, Fairhurst SK, Velicer WF, Velasquez MM, Rossi JS. The process of smoking cessation: An analysis of precontemplation, contemplation, and preparation stages of change. J Consult Clin Psychol. 1991 Apr;59(2):295-304. doi: 10.1037//0022-006x.59.2.295. PMID: 2030191.

[32] Gorini G, Carreras G, Giordano L, Anghinoni E, Iossa A, Coppo A, et al.; SPRINT Working Group. The Pap smear screening as an occasion for smoking cessation and physical activity counselling: Effectiveness of the SPRINT randomized controlled trial. BMC Public Health. 2012 Sep 5;12:740. doi: 10.1186/1471-2458-12-740. PMID: 22950883; PMCID: PMC3491017.

[33] Zabaleta-del-Olmo E, Casajuana-Closas M, López-Jiménez T, et al. Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): A hybrid effectiveness-implementation cluster randomised trial. BMC Public Health. 2021;21:2208. doi: 10.1186/s12889-021-11982-4

[34] Higgins JPT, Savović J, Page MJ, Elbers RG, Sterne JAC. Chapter 8: Assessing risk of bias in a randomized trial. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane handbook for systematic reviews of interventions version 6.4 (updated August 2023). Cochrane, 2023. Available from https://training.cochrane.org/handbook/current Accessed 27 February 2024

[35] Garaschuk O. Understanding normal brain aging. Pflugers Arch - Eur J Physiol. 2021;473:711-712. doi: 10.1007/s00424-021-02567-6

[36] Van den Broucke S, Renwart A. Health literacy mediates the relationship between education level and health behaviour. Eur J Public Health. 2014;24(Suppl 2). doi: 10.1093/eurpub/cku164.012